Outdated assessment process in mental health – Deference to authority figures is no longer the order of the day.


OPINION: THE STEERING group on the review of the Mental Health Act 2001 has just published its interim report. This highlights the contradiction between the paternalistic ethic that informs the Act and the recovery approach advocated by A Vision for Change (the national mental health policy) and the Mental Health Commission.

A key element of the recovery approach is the promotion of patient “empowerment”, including the right to define the nature of one's problems and to be centrally involved in decisions about treatment.

This approach involves questioning the sole authority of the medical perspective in mental health issues.

The report is to be welcomed. But to get beyond paternalism, we (patients, carers, psychiatrists and other professionals) will have to consider how to deal with risk situations without ceding decision-making power to a single professional group.

Consultant psychiatrists are given huge powers and responsibilities under the terms of the Mental Health Act. An application for involuntary detention may be made by a relative or other named individual and a GP is required to support this with a recommendation order.

However, once an individual is detained power resides with the consultant psychiatrist. And they are endowed with the authority to determine the nature of the problem, plus the vocabulary that will be used to describe it.

Moreover, the psychiatrist has the power to determine what treatment will be used, how it will be used and its duration. It is also within the psychiatrist's power to decide what risks to the patient's health will be tolerated.

They can order electroconvulsive therapy even if the patient, or their family, refuses it. Though the patient is seen for a second opinion shortly after admission, this is also carried out by a psychiatrist. The three-person tribunal team that reviews the admission order always includes a psychiatrist.

The powers invested in psychiatry are a legacy of the asylum era and can no longer be justified on scientific or moral grounds.

The 2001 Act not only predates A Vision for Change but also the massive cultural changes we have witnessed in recent years. Scandals involving politicians, banks, financiers and the Catholic Church have seriously undermined trust in our major institutions. Deference to authority figures is no longer the order of the day.

The medical profession has not been without its scandals either. There is evidence that a significant section of academic psychiatry, internationally, has been corrupted by its links with the pharmaceutical industry. Read more…

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